Early Serologic Diagnosis of AQP4+ NMOSD Based on Clinical Factors
In a multicenter, retrospective study, researchers found that more than 60% of patients with aquaporin-4 IgG positive (AQP4+) neuromyelitis optica spectrum disorder (NMOSD) experienced delays in serologic diagnosis.
Rotstein and colleagues sought to determine predictors of time to serologic diagnosis in patients with AQP4+ NMOSD and to understand if early diagnosis and initiation of targeted therapy are associated with better outcomes in the disease.
Using data from CANOPTICS, a Canadian multicenter observational cohort, the researchers retrospectively evaluated the time from the first clinical attack to first positive AQP4-IgG serology. In total 129 participants across seven centers were included in the study, all with AQP4+ NMOSD.
Out of the total cohort, diagnostic delay of greater than 1 month was observed in 82 individuals (63.6%). Further, the researchers evaluated various factors associated with time to diagnosis such as sex, ethnicity, calendar year of diagnosis, and hospitalization for the first attack. In their findings, researchers discovered that Asian compared to White ethnicity, female sex, later calendar year of diagnosis, and hospitalization for the first attack were all associated with shorter times to serologic diagnosis.
Further, researchers did not observe any overall effect in people who are Afro-Carribbean but noted that intersectional effects of ethnicity and social determinants of health should be studied further, as more adverse long-term outcomes were observed in this population.
“In conclusion, in this Canadian study shorter time to serologic diagnosis of AQP4+ NMOSD was associated with hospitalization for the first attack, ethnicity, female sex, and more recent calendar year,” the authors wrote. “Although times to NMOSD diagnosis have improved, clinicians need to consider NMOSD and send AQP4 antibody testing early on even when the patient does not match a classic demographic profile for NMOSD.”
Reference:
Rotstein DL, Freedman MS, Lee L, et al. Predicting time to serologic diagnosis of AQP4+ NMOSD based on clinical factors and social determinants of health. Mult Scler Relat Disord. 2024;83:105434. doi:10.1016/j.msard.2024.105434